AB0362 PROFESSIONAL COUNTRY-WIDE SURVEY ON CLINICAL DECISION-MAKING IN THE TREATMENT OF RHEUMATOID ARTHRITIS
Authors: O. Rusinovich, E. Calvo-Aranda, M. D. C. Uyaguari Morocho, A. Pareja Martinez, P. Navarro Palomo, P. Navarro, M. Cantalejo Moreira, A. J. Diaz Oca, M. Machattou, M. Alonso de Francisco, C. Navarro Joven, M. Fernandez Castro, H. Godoy, C. Merino Argumánez, B. Garcia-Magallon, J. Sanz, C. Barbadillo Mateos, J. Campos Esteban, J. L. Andréu Sánchez, L. F. De Villa, S. Gonzalo Pascua
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Incorporation of conventional synthetic (cs), biologic (b) and targeted synthetic (ts) disease-modifying drugs (DMARDs) has enriched the therapeutic arsenal, but at the same time has complicated the decision-making process, since it requires considering not only the profile of each patient and the characteristics of each drug, but also the high cost of many of them and diverse administrative limitations. <h3>Objectives</h3> To analyze the way of acting of Spanish rheumatologists in different clinical situations in order to understand the decision-making process in the treatment of rheumatoid arthritis (RA). <h3>Methods</h3> A questionnaire that consisted of 15 questions was sent to several groups of rheumatologists country wide between October 19 and 26, 2022. Descriptive statistical analysis and Pearson's Chi2 test were performed to compare responses to the items by the different groups, significance level 0.05 (p&gt;0.05 N.S.) <h3>Results</h3> A total of 108 questionnaires were collected. Work experience of the respondents is reflected in Table 1. In patients with recent-onset RA associated with poor prognostic factors, in addition to corticosteroids half of the respondents (50%) opt to start treatment with csDMARD + rapid escalation to d/tsDMARD if clinical response is insufficient. The most important factor when choosing the drug is the patient´s profile (47.2%), followed by clinical practice guidelines (34.3%). The most relevant factors when choosing each DMARD were: anti-TNF - cost-effectiveness (47.2%); anti-IL6 - efficacy (72.2%); abatacept - efficacy and safety in patients with RA-associated interstitial lung disease (53.7%); rituximab - its safety in patients that didn´t respond to other treatments (76.9%); and JAK inhibitor - its possibility of use in monotherapy (40.7%). The most important factors that lead to change treatment are the disease activity measures (57.4%) and personal perception of the clinician based on anamnesis and physical examination (31.5%). If there is a good therapeutic response, the majority of respondents first taper the b/tsDMARD (50%). If bDMARD-csDMARD combination therapy is used, 59.3% of respondents try to maintain csDMARD in addition to b/tsDAMRD. Regarding the use of corticosteroids, the vast majority of colleagues (79.6%) prefer to try to discontinue them as soon as possible. In case of pregnancy, more than half of the respondents (59.3%) switch to a safer drug. Incidentally diagnosed cancer is a reason for discontinuation of all b/tsDMARD for 47.2% of respondents, while 29.6% additionally discontinue csDMARD and use corticosteroids for disease control; in this clinical situation, respondents with &lt;30 years of work experience discontinue all DMARDs in higher proportion than those with &gt;30 years of work experience (p&lt;0.05). The majority of respondents (80.6%) consider biosimilar drugs to be equally effective and safe as the origininator. <h3>Conclusion</h3> The study revealed a striking heterogeneity in the way of acting in complex clinical situations, which confirms that the decision-making process depends on many factors but also that there is still room for homogenizing clinical practice guidelines in rheumatology. However, there seems to be agreement on the need to minimize systemic exposure to corticosteroids, on the use of disease activity measures to evaluate therapeutic response and on the wide acceptance of biosimilar drugs. <h3>References</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.